A review of the indications and results from various types of primary nerve repairs is presented. Specific data on parameters found to effect overall nerve functional return are detailed. Although primary end-to-end nerve repair appears the ideal treatment for acute injuries, factors outside the surgeon’s control still play an important part in the final outcome.
Complex upper-extremity nerve injuries are a challenging problem for the reconstructive hand surgeon. Traditionally, nerve grafts or tendon transfers have provided options for restoration of function. Advances in nerve repair and in the understanding of the internal topography of the nerve have contributed to the development of the use of nerve transfers. Nerve-to-nerve transfers offer a superior alternative for functional restoration in isolated or multiple nerve injuries when early reinnervation of the target end organ is necessary, such as in proximal injuries or in delayed treatment. Expendable sensory or motor axons close to the end organ allow for earlier regeneration and preclude the need for nerve grafts. Assessment and criteria for nerve transfers as well as the management, surgical techniques, and outcomes for well-established nerve transfers are described.
In cases of recurrent carpal tunnel syndrome requiring revision surgery or in patients who suffer from adhesive neuritis after a primary carpal tunnel release, the prevention of further scar formation allowing nerve gliding and reduced secondary compression owing to scar constriction may be obtained by the use of barrier tissues. This article discusses the use of a vein wrapping technique in patients undergoing secondary nerve decompression or exploration.
A peripheral nerve injury has a profound impact on the patient’s life and such an injury causes high costs for society. A peripheral nerve injury is a very complex injury because it involves both peripheral and central components of the nervous system all the way from targets at muscle and skin receptors up to the brain. In the neuron and its supporting cells—mainly Schwann cells—there are numerous steps in intracellular signaling, signal transduction, that are initiated by the injury with the aim of putting the neuron and the Schwann cells into a regenerative and proliferative condition, respectively. The present article focuses on the basic reactions of the neuron and the Schwann cells during injury and regeneration from a neurobiologic viewpoint. Greater future understanding about the signal transduction mechanisms in neurons and Schwann cells will help to develop pharmacologic strategies in addition to the current surgical treatment options.
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